Wisconsin Licensed Grievance Specialist

Job Summary

Wisconsin Licensed Grievance Specialist, responsible for reviewing and resolving member and provider grievances, complaints, appeals, and provider claim disputes in a full-time role, ensuring compliance with regulatory requirements.

Key Responsibilities

• Review incoming submissions and prioritize urgent matters
• Conduct detailed case investigations and maintain accurate documentation
• Support compliance audits and manage case inventory to meet timelines

Required Qualifications

• High school diploma or equivalent
• 3 or more years of experience in healthcare customer service or grievance and appeals
• Strong knowledge of grievance and appeals processes and insurance regulations
• Familiarity with federal and state regulations governing health insurance complaints
• Experience in health plan operational areas such as customer service and claims processing